Australia and New Zealand

Abstract

The development of diagnostic ultrasound in Australia commenced in 1959 with a research project to build an instrument at the Commonwealth Acoustic Laboratories. By mid-1962, our first images were shown at an International meeting in Pittsburgh (Kossoff et al 1966Kossoff G. Robinson D.E. Garrett W.J. Two-dimensional ultrasonography in obstetrics.in: Grossman C. Diagnostic ultrasound Proceedings of first international conference. Plenum Press, New York1966: 337-347Google Scholar). The team of William Garrett, George Kossoff and David Robinson then began the daunting task of learning to interpret the images, while simultaneously refining the technology to make the images clearer. The Australian contribution to the development of ultrasound encompassed a number of areas. The use of water-bath compound scanning produced wide-area images in the abdomen and pregnant uterus, eye, breast and heart (Kossoff 1975Kossoff G. An historical review of ultrasonic investigations at the National Acoustic Laboratories.J Clin Ultrasound. 1975; 3: 39-43Crossref PubMed Scopus (4) Google Scholar). Developments in technology included pioneering work in developing the grey-scale technique (Kossoff et al 1976Kossoff G. Garrett W.J. Carpenter D.A. Jellins J. Dadd M.J. Principles and classification of soft tissues by grey scale ultrasound.Ultrasound Med Biol. 1976; 2: 89-105Abstract Full Text PDF PubMed Scopus (64) Google Scholar), the UI Octoson (Carpenter et al 1977Carpenter D. Kossoff G. Garrett W.J. Daniel K. Boele P. The U.I. Octoson—a new class of ultrasonic echoscope.Australas Radiol. 1977; 21: 85-89Crossref PubMed Scopus (16) Google Scholar), computer processing of ultrasound signals and images (Knight and Robinson 1987Knight P.C. Robinson D.E. An approach to digital signal processing for ultrasonics research.Ultrasound Med Biol. 1987; 13: 345-352Abstract Full Text PDF PubMed Scopus (7) Google Scholar), tissue characterisation (Robinson et al 1986Robinson D.E. Bamber J.C. Doust B.D. et al.Tissue characterisation at WFUMB’85.Ultrasound Med Biol. 1986; 12: 726-729Google Scholar) and quantitative Doppler flow techniques (Gill 1979Gill R.W. Pulsed Doppler with B-mode imaging for quantitative blood flow measurement.Ultrasound Med Biol. 1979; 5: 223-235Abstract Full Text PDF PubMed Scopus (228) Google Scholar). Current work is in the areas of blood flow quantification, correction of aberration caused by tissue inhomogeneities (Li 1997aLi Y. Phase-aberration correction using near-field signal redundancy—part I Principles.IEEE Trans Ultrason Ferroelect Freq Contr. 1997; 44: 355-371Crossref PubMed Scopus (47) Google Scholar, Li et al 1997bLi Y. Robinson D.E. Carpenter D.A. Phase aberration correction using near-field signal redundancy—part II Experimental results.IEEE Trans Ultrason Ferroelect Freq Contr. 1997; 44: 372-379Crossref PubMed Scopus (21) Google Scholar), and real-time ultrasound telemedicine (Dadd et al 1999Dadd M.J. Gill R.W. Seneviratne S. de Burgh M. Low cost ultrasound teleradiology A practical solution.ASUM Bull. 1999; 2: 17-20Google Scholar). By 1970, ultrasound was being applied clinically outside the research group, and the need was evident for a professional society to provide support to those brave souls attempting to provide a clinical service using this new technique. A meeting called for the purpose of forming a new group, “The Australian Society for Ultrasound in Medicine and Biology,” was held on 17 March 1970. It was attended by 13 people, and a steering committee of George Kossoff, David Robinson and William Garrett was appointed to draft a constitution. The inaugural meeting, held on 20 July 1970, was attended by 18 people with four apologies. The Society was formed into an incorporated company on 2 May 1979. The name changed to the Australasian Society for Ultrasound in Medicine (ASUM) to include New Zealand in 1992. The first annual scientific meeting was held on 31 August 1971 with 68 participants, including 20 from overseas. These annual scientific meetings continue to the present day, normally attracting between 450 and 700 registrants. They have an extensive Australian and New Zealand faculty and a number of invited overseas speakers. The newly formed Society, supported by the active and prominent research group, formed a nucleus of enthusiasm and expertise for the new imaging modality. With this support, ultrasound diagnosis was practiced in Australia and New Zealand at an expert level from the time that commercial equipment first became available. Membership of ASUM is open to all medical practitioners with an interest in the application of ultrasound, scientists and engineers working in ultrasound and sonographers. Voting rights in ASUM are held by medical practitioners, scientists and engineers and qualified sonographers. Unqualified sonographers are associate members. Corporate membership is open to companies providing goods and services in ultrasound. The council of the society consists of a directly elected president, vice president, secretary and treasurer, seven councillors elected by medical practitioner members, five by qualified sonographers, one by scientists/engineers, one by associate members and one by corporate members. The current membership of ASUM is 2347, including 1435 medical practitioners, scientists, engineers and qualified sonographers, 825 associate members, 20 corporate members, eight life members, 26 honorary members, 18 retired members, 14 corresponding members and one trainee. The Society publishes the ASUM Bulletin four times per year, a high quality journal containing scientific and educational articles and ASUM news. It also conducts monthly local scientific and educational meetings, and annual courses in specialised subjects at various venues throughout Australia and New Zealand. It plays a leading role in negotiations with government and other Colleges on matters relating to the delivery of ultrasound services. Concurrently with the formation of the Australian Society, steps were taken to form the World Federation, in which ASUM was heavily involved. George Kossoff and William Garrett attended the first meetings of the Federation, and later served as president and vice-president respectively. David Robinson served as secretary of the Federation for 9 years, and then as a vice-president. One highlight of Australasia’s contribution to the activities of WFUMB was conducting the WFUMB’85 congress in Sydney. This stretched the existing conference facilities of the city to their limit, using two major venues in the heart of the city. The conference was attended by 1100 registrants, and made a substantial surplus, putting both ASUM and WFUMB on a sound financial footing. Another major contribution was by Drs. Kossoff and Barnett, who organised a series of working meetings on safety and standardisation, resulting in the publication of a special report representing WFUMB policy on the safe use of ultrasound (Barnett 1992Barnett SB, Kossoff, G (Eds.). WFUMB Symposium on safety and standardization in medical ultrasound: Issues and recommendations regarding thermal mechanisms for biological effects of ultrasound [special issue], Ultrasound Med Biol 1992;18(9).Google Scholar). These activities continue within WFUMB and form a major part of its contribution to the field. By 1976, the use of ultrasound was spreading rapidly in Australia and New Zealand. Unfortunately, knowledge in ultrasound was not spreading as rapidly, and sometimes accuracy of diagnosis suffered. Any medical practitioner could buy an ultrasound machine and offer diagnoses. To emphasise the need for training, and to set the standard of knowledge and experience considered appropriate, ASUM established the diploma of diagnostic ultrasound (DDU). The examination for this diploma is in two parts. Part I consists of a written paper in the basics of ultrasound, including the physics and technology of diagnostic ultrasound and biological effects. Part II is open to those candidates who have passed the part I examination and who are Fellows of the Australasian College of Emergency Medicine, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, the Royal Australasian College of Physicians, the Royal Australian and New Zealand College of Radiologists, the Royal Australasian College of Surgeons, or who hold an equivalent diploma in one of these disciplines, which is recognised in Australia. The part II examination consists of a written paper, an oral examination, case reporting and an anatomy test. A practical test of scanning proficiency may be included. The examination is structured so that candidates may take the examination in: general ultrasound; cardiology; obstetrics, gynaecology and neonatal paediatrics; surgery; vascular studies; ophthalmology; paediatrics. The first diplomas were granted in 1976, and currently 448 DDUs have been awarded. The DDU was among the first formal qualifications for the practice of diagnostic ultrasound in the world. It has achieved its stated aim in Australia and New Zealand by setting the standard of knowledge required in the subject for effective practice. In 1983, the Royal Australian and New Zealand College of Radiologists introduced ultrasound into its training requirements and began examining in the subject, and approximately 600 Fellows of the College have now received training equivalent to the DDU in scope. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists encourages its Fellows to obtain the DDU if they wish to perform diagnostic ultrasound services. The RANZCOG also awards a subspecialty certificate for those Fellows wishing to undertake tertiary referral practice in diagnostic ultrasound and prenatal diagnosis. However, it is still not mandatory to hold a recognised qualification to practise diagnostic ultrasound in Australia or New Zealand. In 1979, ASUM established the diploma of medical ultrasonography (DMU) for sonographers. The prerequisite educational qualifications for the DMU are a diploma or degree issued by appropriate authorities in: nuclear medicine science; nursing; midwifery; diagnostic radiography; therapeutic radiography; cardiopulmonary technology; medical technology; science; and medical degrees not registrable in Australia or New Zealand. The examination for the diploma is in two parts. Part I covers the physical principles of ultrasound, instrumentation, anatomy, embryology, physiology and general principles of pathology. The part II examination consists of a written paper on ultrasound techniques which may include patient care, scanning techniques, organ specific pathology, complementary imaging examinations and all the subjects covered in part I, as well as a practical examination in scanning techniques and an oral examination. The DMU examinations for general candidates cover all aspects of medical sonography. However, candidates may seek to be examined in echocardiography, vascular or obstetric ultrasound, and such diplomas are so endorsed. This qualification is not mandatory in Australia, but it is recognised by the New Zealand Health Department as a necessary requirement for working in sonography. Since 1979, a total of 959 DMUs have been awarded. In the last 10 years, a number of universities have offered formal degree courses in ultrasonography. Graduates of these courses rank with DMU holders as “qualified sonographers.” There are currently an estimated 500 such graduates. Provision of medical services in Australia is funded by a mixture of Federal and state government funding, medical insurance and private payment by the patient. Medical practitioner services are provided on a fee-for-service basis. For each type of service, a “schedule fee” is determined. A similar arrangement exists in New Zealand. In Australia, the Federal government’s Medicare scheme, funded in part by a 1.75% levy on taxable income for all personal taxpayers, refunds 85% of the schedule fee for each service rendered. The medical practitioner can elect to “bulk bill” all or a certain category of his or her services directly to Medicare. In this case, only 85% of each fee is refunded. Alternatively, the medical practitioner may elect to charge the patient directly. The fee charged may exceed the schedule fee, but only 85% of the schedule fee is refunded to the patient by Medicare. Hospital care is provided by a system of public and private hospitals. The public hospital system is funded by a formula from the Federal government to each state, with the latter being responsible for provision of hospital services. In a public hospital, there is no charge to the patient for hospital, medical, pharmaceutical, diagnostic or ancillary services. Public hospital services are limited by funding limitations, and waiting lists are common. In parallel with the public system is a private hospital system, which charges patients for both medical and hospital services. The medical services in a private hospital are subject to the Medicare refund of 85% of the schedule fee, and hospital services may be covered by health insurance, although again not all costs are refunded. Recent developments aimed at controlling health costs include government incentives to increase the proportion of the population with private insurance, a series of arrangements between private insurers and health care providers, and the introduction of casemix funding and coordinated care trials. The Medical Practitioners Act in Australia places no limitation on the area of practice of registered medical practitioners. There is no legal impediment for any registered practitioner to set up practice, for instance, in diagnostic ultrasound. Fundamentally, control of practice in diagnostic ultrasound is exerted by community expectation that practitioners limit themselves to their area(s) of expertise. The current Medicare benefit for ultrasound is different for self-referred and referral practice, giving some protection against over-servicing. Reputable ultrasound practices are typically run by radiologists, obstetricians, cardiologists or vascular surgeons who have satisfied the qualification requirements of their medical college or hold the DDU. In most cases, the sonographers employed in these practices are also qualified, typically with the DMU, or are in training to sit the DMU. The equipment used is of a high standard, with the units being mainly bought or upgraded within the previous 5 years. The full range of ultrasound services is provided. In conclusion, the standard of practice in the provision of ultrasound diagnostic services in Australia and New Zealand is high. In a combined population of around 22 million, a figure of approximately 1000 (or 45 per million) qualified sonologists, and 1500 (or 68 per million) qualified sonographers is thought to be very high by world standards.